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Archive for April, 2017

Dr. Faria Khan

Tuesday, April 25th, 2017
Dr. Faria Khan

Dr. Faria Khan

Dr. Faria Khan is a board certified adult and pediatric allergist originally from Eufaula, Alabama. She attended Auburn University for her undergraduate studies and earned her MD at the University of Alabama School of Medicine in Birmingham. She did her internal medicine residency at Emory here in Atlanta after which she practiced internal medicine in Pensacola, Florida for a few years. She decided to specialize in the field of allergy and completed fellowship (specialty) training at Baylor in Houston, Texas. She first practiced allergy in Houston at McGovern Allergy and Asthma Clinic and then returned to Atlanta where she practiced in Alpharetta and Johns Creek for the past few years before joining Atlanta ENT, Sinus & Allergy Associates, PC.

In addition to her allergy career, Dr. Khan is heavily involved in organized medicine in order to improve healthcare for patients across the state of Georgia. She is a member of the Board of Directors and Communication Chair of the Medical Association of Atlanta (MAA). She is also a member of the Medical Association of Georgia (MAG) and was recently appointed to the MAG Judiciary Committee. She has served as a Delegate to the House of Delegates through MAG for the past two years. She is also a part of the current class of the Georgia Physicians Leadership Academy. Finally, she is part of the Member Relations committee for the American College of Allergy, Asthma, and Immunology (ACAAI).

Dr. Khan enjoys all the different aspects of allergy including allergic rhinitis, skin allergies, asthma, and eye allergies.

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Dian “Tossy” Fogle, M.D.

Tuesday, April 25th, 2017
Dian Fogle

Dian “Tossy” Fogle, M.D.

Dr. Fogle is a perinatologist at Georgia Perinatal Consultants. She received her B.A. from Vanderbilt University and her M.D. from LSU in New Orleans. She completed her residency and fellowship at Emory University. Dr. Fogle is board certified in Obstetrics & Gynecology and Maternal-Fetal Medicine. Her primary interests include prenatal diagnosis and complications of pregnancy. Dr. Fogle is on staff at Northside Hospital, Piedmont Hospital and WellStar Kennestone Regional Medical Center.

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Douglas W. Lundy, MD, MBA, was named chair of the American Academy of Orthopaedic Surgeons Council on Advocacy

Monday, April 24th, 2017

Georgia orthopaedic trauma surgeon Douglas W. Lundy, MD, MBA, was named chair of the American Academy of Orthopaedic Surgeons (AAOS) Council on Advocacy at the organization’s 2017 Annual Meeting. 

Dr. Lundy is co-president of Resurgens Orthopaedics in Marietta, Ga., specializing in the care of patients with multiple injuries and complex fractures. He practices at WellStar Kennestone Hospital where he is co-chair of the WellStar Musculoskeletal Service Line and past-chief of surgery. 

Dr. Lundy graduated from North Georgia College in Dahlonega, Ga., and the Medical College of Georgia – Augusta University in Augusta, Ga. He completed his post-graduate training at Georgia Baptist Hospital in Atlanta and Vanderbilt University Medical Center in Nashville. In 2014, Dr. Lundy received his MBA from Auburn University in Auburn, Ala.

Dr. Lundy is a member of AAOS, he served as treasurer of the Association’s Orthopaedic PAC, a member of the Council on Advocacy, Communications Cabinet and as past-chair of the Medical Liability Committee. 

Since 2012, Dr. Lundy has served as a director of the American Board of Orthopaedic Surgery and is the treasurer and chair of the Oral Examination Committee. He is the chief financial officer-elect for the Orthopaedic Trauma Association (OTA). He previously served on the OTA’s Board of Directors as a member-at-large leading the effort of the OTA to produce performance measures with the AAOS, and also as chair of the OTA Health Policy Committee, and on its Board of Specialty Societies. 

Dr. Lundy also is involved in foreign medical missions in Eastern Europe, Haiti, Asia and especially sub-Saharan Africa through the Christian Medical and Dental Association and the Pan-African Academy of Christian Surgeons. He and his wife Peggy, and their two sons reside in Mableton, Ga.

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Christy M. Norman joins Emory Healthcare as Vice President of Pharmacy Services

Thursday, April 20th, 2017
Christy M. Norman,

Christy M. Norman

Christy M. Norman, PharmD, MS, has been named vice president of pharmacy services at Emory Healthcare. Norman comes to Emory from Augusta University Medical Center, where she held the positions of administrative director of pharmacy and director of pharmacy residency programs. She is also a clinical assistant professor at the University of Georgia College of Pharmacy.

In this new position, Norman will lead pharmacy services across Emory Healthcare’s full enterprise, providing strategic leadership to manage pharmacy services, as well as administrative support to all hospital and clinic pharmacies throughout the Emory system. She will also oversee safety and performance standard processes in compliance with organizational and regulatory guidelines.

Norman received a Doctor of Pharmacy from University of Georgia and a Master of Science in Health-System Pharmacy Administration from The Ohio State University.

“Christy’s expertise will provide strategic direction for our pharmacy services across the system, with a focus on standardization of clinical processes, pharmacy workflow practices and quality improvements,” says Dane C. Peterson, Emory Healthcare Hospital Group President. “We look forward to her leadership in this arena.”

“I am thrilled with the opportunity to join the team at Emory Healthcare,” says Norman. “I look forward to working with my colleagues by building on the strong foundation that has already been established in pharmacy services at Emory and elevating the practice of pharmacy to the next level.”

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Sports Medicine and Orthopaedic Surgeon, S. Clifton Willimon, M.D, Named Medical Director of The Atlanta United Academy

Thursday, April 20th, 2017
S. Clifton Willimon, M.D.

S. Clifton Willimon, M.D.

Children’s Healthcare of Atlanta and Atlanta United have named S. Clifton Willimon, M.D. as medical director of the club’s Academy teams. In his role, he will provide pediatric sports medicine and orthopaedic care to youth players as part of Children’s Healthcare of Atlanta’s role as the official pediatric sports medicine program of Atlanta United. He will also support the Atlanta United First Team as a team physician.

Dr. Willimon is a board-certified orthopaedic surgeon and the Medical Director of Orthopaedic Quality and Outcomes at Children’s. He specializes in advanced arthroscopic and reconstructive surgical techniques for the treatment of complex orthopaedic disorders of the knee, hip, shoulder and elbow as well as sports injuries.

Throughout his career, Dr. Willimon has cared for professional and Olympic athletes as well as collegiate, high school and recreational athletes. He currently serves as team physician for the East Cobb Yankees and Mount Vernon Presbyterian School.

“Our clinical team is trained in pediatrics, so we understand the demands and pressures young athletes face as they play sports; and we know they need to be managed differently than adults,” said S. Clifton Willimon, M.D., medical director for Atlanta United Academy. “Our multidisciplinary team of certified athletic trainers, physical therapists, sports medicine physicians and orthopaedic surgeons work in concert to evaluate injured athletes and determine the best course of treatment to help them return safely to the field.”

Dr. Willimon completed medical school at Emory University School of Medicine and his orthopaedic residency at Duke University Medical Center where he was chief resident and a resident team physician for Duke University Athletics, North Carolina Central University and Hillside High School. During his time at Duke, he also completed training in pediatric orthopaedic surgery at Children’s. After residency, he received specialized training at the Steadman Clinic and Steadman Philippon Research Institute in Vail, Colo. where he trained under leaders in sports medicine. Dr. Willimon currently collaborates with Georgia Institute of Technology for cartilage research.

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Grady First Metro Hospital to Link Pump and EMR System

Thursday, April 20th, 2017
Alaris IV smart pump

Alaris IV smart pump

Grady is Metro Atlanta’s first hospital to integrate the Alaris IV smart pump technology with its Epic electronic medical record (EMR). To date, approximately 25% of U.S. hospitals have achieved smart pump-EMR interoperability.

“The ability to link programmable IV infusion pumps directly to patient medical records significantly decreases the chances of medication administration errors,” said Glenn Hilburn, Vice President, Clinical Systems, Grady Health System. “We are able to reduce the number of steps a nurse does from 21 down to three. Fewer steps means fewer chances for mistakes and greatly improved efficiency,” Hilburn added.

The smart pump-EMR interoperability rollout on March 1 was the latest step in Grady’s technology journey. By linking the smart pump to the patient’s medical record, clinicians are able to make sure the right drug is given to the right patient, within the right dose, and at the right time.

“The system validates the infusion against the physician’s order through barcode technology and programs the pump to dispense the medication. In addition, it sends data back to the medical record as the patient receives the infusion, providing important, real-time information for the patient care team,” Hilburn said. “This interoperability is recognized throughout healthcare as a best practice.”

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New Northside Hospital Cherokee to Open

Thursday, April 20th, 2017
Northside Hospital Cherokee

New Northside Hospital Cherokee to Open

Northside Hospital Cherokee’s replacement hospital will open for patients on Saturday, May 6, 2017.

The new hospital is located off I-575 at the Ga. Hwy 20 exit.

“This is a huge move forward for Cherokee county and the surrounding areas,” said Billy Hayes, CEO of Northside Hospital Cherokee. “Our new hospital is the culmination of a lot of hard work by many people over many years. The entire Northside Cherokee family is proud of what we’ve accomplished, and we look forward to a new era of health care service.”

Construction is complete on the new hospital, which will open with 105 inpatient beds and more than twice the square footage as the current hospital. Northside staff is now focused on training and education, while overseeing the installations of equipment and furniture.

A medical office building opened on the 50-acre campus in early January. Several physician practices and Northside Hospital Radiation Oncology have opened their offices and are seeing patients. Additional Northside services and physicians will move into the building over the next several months.

Northside is planning an open house for late April to give everyone a chance to tour the new hospital campus before patients are moved and accepted there on May 6.

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Current Management of Twin Gestation

Wednesday, April 19th, 2017

By Tossy Fogle, M.D.

The twin birth rate hit a new high in 2014 at 33.9 twins per 1,000 births.1 This has been attributed to an older maternal age at conception, which naturally increases the rate of twinning, and an increased use of assisted reproductive technology. The triplet and higher-order multiple birth rate peaked in 1998 at 193.5 births per 100,000 births. Since then, the rate of higher-order multiple births has decreased by 40 percent (113.5 per 100,000 births in 2014) likely due to a change in assisted reproductive technology procedures 1

Fetal and Infant Morbidity and Mortality 

Multiple gestations are inherently at increased risk for maternal and neonatal morbidity and mortality and are associated with significantly higher healthcare costs. The rate of preterm labor and delivery, cesarean delivery, fetal growth and amniotic fluid abnormalities, structural abnormalities, preeclampsia, gestational diabetes, stillbirth and neonatal morbidity/mortality increases as the number of fetuses increase.

One of the greatest complications is preterm birth or delivery prior to 37 weeks gestation (spontaneous or iatrogenic). This occurs in up to 60 percent of twin gestations.2 The risk for long-term morbidity is inversely associated with gestational age at the time of delivery. Preterm infants are at increased risk for breathing and feeding difficulties, developmental delay, cerebral palsy, necrotizing enterocolitis, intraventricular hemorrhage, and vision and hearing impairment.

The risk for stillbirth is also significantly increased. In 2009, the associated stillbirth rate was 12 per 1,000 twin births and 31 per 1,000 triplet and higher-order multiple births compared to five per 1,000 singleton births.3,4

In an effort to improve outcomes of twin gestations, ultrasound assessment of chorionicity, fetal anatomy, biometry, Doppler velocimetry and amniotic fluid volume has become standard practice. Also, consultation with a tertiary care center should be considered in all twin gestations.

The First Trimester Ultrasound

First trimester ultrasound in twin gestations is key to establishing dating and to determining chorionicity and amnionicity. This information dictates the frequency of the need for follow-up imaging. During this exam, the membrane thickness at the site of the insertion of the amniotic membrane into the placenta is evaluated as well as the presence or absence of the “lambda sign.” (See Image 1.)

Example of the “Iambda sing” (Image 1).

In a dichorionic diamniotic (DCDA) gestation, each fetus has its own placenta and amniotic sac, and a lambda sign should be present at the insertion of the amnion into the placenta. If the fetuses are sharing a placenta – or monochorionic-diamniotic twins – the dividing membrane will be thin (<2mm) and a “T sign” will be present. (See Image 2.) A monochorionic monoamniotic (MCMA) gestation will share the same placenta and amniotic sac. This occurs in approximately 1 in 30,000 to 1 in 60,000 pregnancies.

Once the type of twinning is determined, then labeling of the twin fetuses should be performed in a consistent and reliable way. This allows consistency in follow-up imaging and is especially important in cases with fetal structural concerns or growth and amniotic fluid abnormalities. Typically, twins are identified by mapping their cord insertion into the placenta and/or labeling “left or right” and “upper or lower.”

Twin Gestation

Example of the “T-sign” (Image 2).

If there is confusion about the chorionicity, amnionicity or dating, then referral to a tertiary care center is recommended. It is also recommended in all cases of monochorionic twinning.

Aneuploidy Screening 

Aneuploidy screening in multifetal gestations is not as sensitive as in singleton gestations. This is due to analytes from both fetuses being averaged together, which can potentially mask abnormal values. Nuchal translucency screening in the first trimester with the addition of biochemical testing is the current standard for twin gestations. Noninvasive prenatal testing, which evaluates fetal cell free DNA in maternal serum, is a potential screening tool for aneuploidy, but more information is needed before this testing becomes standard of care.9

Second and Third Trimester Follow Up

Dichorionic Diamniotic Gestations

Patients with an uncomplicated dichorionic diamniotic twin gestation should have a targeted anatomical survey at 18- to 20-week gestation. Thereafter, monthly follow-up for evaluation of interval growth and fluid assessment is recommended. Antenatal testing is not recommended in uncomplicated dichorionic twin gestations.

If the fetal growth remains concordant and there are no other comorbidities, then delivery is usually recommended at 37 to 38 weeks gestation. This is supported by a 2016 systematic review of timing of delivery in uncomplicated dichorionic twin gestations. This study found that the risk of stillbirth was equivalent to the rate of neonatal death at 38-39 weeks, and therefore delivery during the 37-38 week window minimizes the risk of perinatal deaths near term.5

Monochorionic Diamniotic Gestations

Monochorionic twins have more complications, require more frequent follow up and should be managed in a tertiary care center. Monochorionic diamniotic twins develop twin-twin transfusion syndrome (TTTS) in 9 percent to 15 percent of pregnancies6,7 while monochorionic monoamniotic develop TTTS in 6 percent of pregnancies.8 Both are also at risk for developing twin anemia polycythemia sequence (TAPS). This is a condition in which the hematocrits differ significantly without development of oligohydramnios and polyhydramnios. Monochorionic gestations are inherently at higher risk for anomalies and stillbirth.

Uncomplicated monochorionic pregnancies should have imaging every 2 weeks starting in the second trimester to assess for TTTS and TAPS. If these complications occur, then referral to a fetal therapy center for laser ablation of the communicating placental vessels is recommended. If complications do not arise, then surveillance at 2 week intervals should continue until antenatal testing is instituted around 32 weeks gestation.

If the pregnancy progresses without complication, then delivery is recommended at 36 to 37 weeks gestation. This is due to the increased risk of stillbirth in monochorionic gestations. This is supported by the 2016 systematic review on timing of uncomplicated monochorionic diamniotic twin gestations, which found a trend toward an increased rate of stillbirths than neonatal deaths beyond the 36th week gestation.8 There are no randomized controlled trials on this issue to guide management.

Monochorionic Monoamniotic Gestations

Monochorionic monoamniotic twin gestations occur in approximately 1 percent of twin gestations and are complicated by an increased risk for stillbirth due to entanglement of the umbilical cords, structural abnormalities, TTTS & TRAPS. These pregnancies are followed closely with ultrasound, and ultimately patients are admitted in the early third trimester for intensive surveillance. Mono-mono gestations typically are delivered by 32-34 weeks gestation by cesarean delivery.

Mode of Delivery

Route of delivery for twins is typically individualized and is based on many factors. More than 60 percent of twin births are by cesarean delivery.9 Factors such as presentation of each twin, chorionicicty/amnionicity, estimated fetal weights, structural concerns and maternal co-morbidities are considered when planning mode of delivery.

Take Home Points

Twin gestations are inherently at increased risk for maternal and neonatal morbidity. Consultation with a tertiary care center or perinatologist early in gestation is helpful to determine pregnancy risks and to establish a management plan. A multidisciplinary team approach is critical to achieving a healthy outcome for mom and baby.

 

Citations:

  1. Hamilton BE, Martin JA, Osterman MJ, Curtin SA, Mathews TJ. Births: final data for 2014. Natl Vital Statistics Report 2015; 64:1-64.
  2. Martin JA, Hamilton BE, Ventura SJ Osterman MJ, Kirmeyer S, Mathews TJ, et al. Births:final data for 2009 Natl Vital Statistics Report 2011;60:1-70.
  3. Tucker J, McGuire W. Epidemiology of preterm birth. BMJ 2004; 329: 675–
  4. Garne E, Andersen HJ. The impact of multiple pregnancies and malformations on perinatal mortality. JPerinatMed2004; 32: 215–8.
  5. Cheong-See F, Schuit E, Arroyo-Manzano D, et al. Prospective risk of stillbirth and neonatal complications in twin pregnancies: systematic review and meta-analysis. BMJ 2016; 354:i4353.
  6. Sebire NJ, Snijders RJ, Hughes K, et al. The hidden mortality of monochorionic twin pregnancies. Br J Obstet Gynaecol 1997; 104:1203.
  7. Lewi L, Jani J, Boes AS, et al. The natural history of monochorionic twins and the role of prenatal ultrasound scan. Ultrasound Obstet Gynecol 2007; 30:401.
  8. Steer P. Perinatal death in twins. BMJ 2007; 334:545.
  9. Practice Bulletin No. 169: Multifetal Gestations: Twin, Triplet, and Higher-Order Multifetal Pregnancies. Obstet Gynecol 2016; 128:e131.
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Burning Out in Georgia

Wednesday, April 19th, 2017

By Faria Khan, M.D.

A thirty-eight year old physician friend of mine recently told me, “I’m just going to stick it out another 15 years, but I hate this. I’m trying to find something good to invest in so I can retire early.” She’s not the only one who has told me something along these lines. After all our years of training, are we not enjoying what we do? Is this just stress talking or is it something bigger?

Chances are you have if you have been practicing medicine in the United States within the past ten years, you have heard about physician burnout. Numerous articles have been written about it by various sources such as Medscape, Huffington Post, US News, and many more in response to multiple international studies reporting this phenomenon in medicine. In 2011, the AMA along with researchers at the Mayo clinic, conducted a study that focused on burnout in US physicians compared to physicians in other parts of the world. Over 7,000 doctors were given a 22-item questionnaire (the Maslach Burnout Inventory or MBI) concerning the three defining features of burnout – emotional exhaustion, depersonalization, and doubt. The study showed that burnout is significantly more common in doctors compared to other working professionals. It also found that physicians in primary and emergency care settings are at greatest risk. (1)

Three Symptoms of Burnout:

Feelings of being worn-out or spent emotionally – emotional exhaustion.

Inability to empathize with patients; cynicism towards patients- depersonalization.

Feelings that career is meaningless- doubt.

 

So, is burnout just stress? Although stress is the number one predictor of burnout, there is a distinction between the two. Dike Drummond, MD, professional business coach and author, says that the difference has to do with the ability to recover from the above symptoms during time away from work. If a physician is able to re-energize during time off, she is stressed at work. If she cannot re-energize away from work, she is burned out. (5,6)Looking specifically at Georgia, a survey of over 500 physicians showed that over half the doctors in the state have experienced symptoms of burnout “always” or “often”. Several of the surveyed doctors were in their mid 50s or older and were considering early retirement because of it. (3,4)(2)

Despite the recent media attention, burning out professionally is not a new idea. In 1974, the word “burnout” was originated and described by psychologist Herbert Freudenberger. In the years following, occupational burnout was found to be particularly associated with professions that deal with human services. In addition to physicians and nurses, other professionals with significant levels of burnout include teachers, police officers, customer service respresentatives, social workers, and lawyers. By the early 1980’s, psychologist Christina Maslach introduced the MBI which is considered the gold-standard in the evaluation of burnout. More recently, studies have suggested that burnout may actually be a form of depression as many features are similar. (7)

The rise of burnout in medicine is thought to be a result of the unique pressures of modern practice. As we doctors know, the practice of medicine can be very challenging and intense. As more physicians become employed rather than owning their own practices, they begin to feel like robots who are: expected to meet carefully measured productivity targets which are tied to compensation, monitored constantly by insurers that set strict rules on the use of medications and procedures, and required to submit an incredible amount of time-consuming documentation for reimbursement. Even when all the painstaking documentation is close to perfect, reimbursement rates continue to decline. In addition to less patient time, many physicians are expected to stay “plugged in” despite being away from their clinic/hospital for out-of-office issues that might arise. (8)

Increasingly, there is evidence suggesting that burnout may increase medical errors, worsen quality of care, cause a loss of professionalism, and foster early retirement (a serious concern as the medical needs of our aging American population continue to rise). Burnout has also been linked to alcohol and drug abuse, destroyed relationships (physicians have a higher rate of divorce than the rest of the American population), and suicide. In fact, doctors are at least twice as likely to kill themselves compared to the general population. Approximately 400 physicians commit suicide yearly. (9,10,11)

Some experts feel that the rates of burnout might be over-reported for many reasons including the idea that the symptoms captured by the MBI might be transient (not persistent) therefore showing stress not burnout. Others point out that there is no convincing evidence that suicide is directly connected to burnout. Nevertheless, most physicians feel that professional wellness is a priority and that some emphasis should be placed on this for more work-life balance. (12,13,14)

Cognitive behavioral therapy which focuses on changing a pattern of thinking in order to change feelings and cognitive restructuring which focuses on identifying and stopping maladaptive thought processes have both been the mainstay of occupational burnout prevention and treatment for the individual. Other traditional tools include stress management, relaxation techniques, and schedule changes. When looking only at prevention, tips such as beginning one’s day with a relaxation technique (such as meditation), exercise, healthful eating, good sleep, boundary setting, technology breaks, and the nourishment of one’s creative side have been shown to be successful. Beyond individual treatment and equally important in the prevention of burnout, according to Maslach and Leiter, is supportive leadership within the employee’s organization that ensures resources that promote work/life balance and energy revitalization.

Using the above ideas as a guide, many proposals have been put forth regarding treatment of physician burnout. As early as 2001, an article published in the Annals discussed treatment and prevention of this syndrome. (15) Tips at the time included joining a support group, considering therapy, attending wellness conferences, and addressing spiritual needs. Other suggestions throughout the years included taking breaks and staying connected to things outside of medicine (hobbies).

In Italy, pediatric oncologists who underwent a program of art therapy demonstrated a significantly decreased level of burnout (16). At the Mayo clinic in Jacksonville, Florida, art classes and meditation time for internal medicine residents were found to decrease burnout. This has led to the established the Fellows’ and Residents’ Health and Wellness Initiative (FERHAWI) humanities program which gives residents protected time within their schedules to focus on guided visual imagery, art (origami and painting), and discussion of art. (17)

Stanford has created the Balance in Life program which emphasizes psychological, physical, social, and professional wellness for its residents. Key factors in their program include resident mentorship, healthy food options for snacks while at work, scheduled meetings for counseling, and scheduled social gatherings. (18) For its emergency department physicians, Stanford has created a time banking program. Meal delivery, babysitting, handyman services, elder care, dry cleaning pickup, housecleaning, and other services are given back to doctors who earn credits for these perks when spending time on mentoring, committee work, and last minute shift coverages – things that are often inherent parts of modern day practice that drain time away from family, friends, and other activities. (19) The “Steps Forward” module was created by the AMA as a curriculum guide for medical training institutions in order to encourage the establishment of successful wellness programs for their doctors-in-training.

There is some evidence that the practice of mindfulness (being totally present and in the moment) is a promising tool for combating burnout. A handful of smaller studies show that training courses on mindfulness help physicians increase empathy and decrease emotional exhaustion. One criticism of this is that training in this takes time which is difficult to find in physicians’ already time-demanding careers. (20)

The good news is many of these ideas seem to be working. Maybe we can get back to enjoying our careers every day instead of just “sticking it out”!

 

REFERENCES:

  1. (Shanafelt, M. T. (2012). Burnout and Satisfaction With Work-Life Balance Among US Physicians Relative to the General US Population. Retrieved November 17, 2016, from http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1351351).
  2. (Drummond, D. (2014).Stop physician burnout: What to do when working harder isn’t working. United States: Heritage Press Publications.)
  3. (Miller, A. (2016). Many Georgia doctors are dissatisfied, survey shows. Retrieved November 14, 2016, from http://www.georgiahealthnews.com/2016/10/georgia-doctors-dissatisfied-survey-shows/).
  4. (Cryts, A. (n.d.). Many Georgia docs burned out, look to early retirement. Retrieved November 14, 2016, from http://www.fiercehealthcare.com/practices/many-georgia-docs-burned-out-likely-to-pursue-early-retirement).
  5. (Drummond, D. (2014).Stop physician burnout: What to do when working harder isn’t working. United States: Heritage Press Publications.)
  6. (How to beat burnout: 7 signs physicians should know. (2016). Retrieved November 17, 2016, from https://wire.ama-assn.org/life-career/how-beat-burnout-7-signs-physicians-should-know)
  7. (Occupational burnout. (n.d.). Retrieved November 20, 2016, from https://en.wikipedia.org/wiki/Occupational_burnout)
  8. (Shanafelt, T., MD, & Dyrbye, L., MD. (n.d.). Journal of Clinical Oncology. Retrieved November 17, 2016, from http://ascopubs.org/doi/abs/10.1200/jco.2011.39.7380)
  9. (Sinha, P. (2014). Why Do Doctors Commit Suicide? Retrieved November 17, 2016, from http://www.nytimes.com/2014/09/05/opinion/why-do-doctors-commit-suicide.html) (Sifferlin, A., & Sifferlin, A. (n.d.).
  10. Is Your Doctor Burned Out? Nearly Half of U.S. Physicians Say They’re Exhausted | TIME.com. Retrieved November 17, 2016, from http://healthland.time.com/2012/08/21/is-your-doctor-burned-out-nearly-half-of-u-s-physicians-say-theyre-exhausted/)
  11. (Shanafelt, T., MD, & Dyrbye, L., MD. (n.d.). Journal of Clinical Oncology. Retrieved November 17, 2016, from http://ascopubs.org/doi/abs/10.1200/jco.2011.39.7380)
  12. ( Sifferlin, A., & Sifferlin, A. (n.d.).
  13. Is Your Doctor Burned Out? Nearly Half of U.S. Physicians Say They’re Exhausted | TIME.com. Retrieved November 17, 2016, from http://healthland.time.com/2012/08/21/is-your-doctor-burned-out-nearly-half-of-u-s-physicians-say-theyre-exhausted/)
  14. (Cox, E., MD. (n.d.). Doctor Burnout, Stress and Depression: Not an Easy Fix … Retrieved November 15, 2016, from http://health.usnews.com/health-news/patient-advice/articles/2016-04-12/doctor-burnout-stress-and-depression-not-an-easy-fix).
  15. (Gundersen, L. (2001). Physician Burnout. Retrieved November 20, 2016, from http://annals.org/aim/article/714658/physician-burnout)
  16. (Italia, S., Favara-Scacco, C., Cataldo, A. D., & Russo, G. (2008). Evaluation and art therapy treatment of the burnout syndrome in oncology units.Psycho-Oncology, 17(7), 676-680. doi:10.1002/pon.1293).
  17. (Henry, T. A. (2016). Preventing burnout in residency programs: Mayo Clinic’s unique approach. Retrieved November 23, 2016, from https://wire.ama-assn.org/education/preventing-burnout-residency-programs-mayo-clinics-unique-approach).
  18. (Vassar, L. (2016). How one program achieved resident wellness, work-life balance. Retrieved November 23, 2016, from https://wire.ama-assn.org/life-career/how-one-program-achieved-resident-wellness-work-life-balance)
  19. (Schulte, B. (n.d.). Time in the bank: A Stanford plan to save doctors from burnout. Retrieved November 23, 2016, from https://www.washingtonpost.com/news/inspired-life/wp/2015/08/20/the-innovative-stanford-program-thats-saving-emergency-room-doctors-from-burnout/).
  20. (Shapiro, S. L., & Carlson, L. E. (2009).The art and science of mindfulness: Integrating mindfulness into psychology and the helping professions. Washington, DC: American Psychological Association.)
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Life on MARS: Emory Leads the Way in Artificial Liver Support

Wednesday, April 19th, 2017
MARS by Emory

MARS® (Molecular Adsorbents Recirculating System) by Emory

Emory is one of a few centers in the U.S., and the most experienced in the country, to offer MARS® (Molecular Adsorbents Recirculating System), a novel system that filters out more toxins from the blood than conventional dialysis.

Over the past few years, Emory has used MARS to treat more than 150 patients with acute liver failure and acute-on-chronic liver failure. It has been used:

  • in facilitating intrinsic hepatic recovery following liver failure
  • as a bridge to liver transplantation
  • in the post-transplant phase of primary graft dysfunction and non-function

 

How MARS Works

MARS combines albumin dialysis with conventional dialysis to clear both albumin-bound and water- soluble toxins from the blood. The system works by first passing the patient’s unfiltered blood through the MARS FLUX dialyzer, which uses clean albumin dialysate to draw water-soluble and protein-bound toxins from the blood through a specialized membrane.

The toxin-rich albumin dialysate passes through a conventional dialysis system to remove water-soluble toxins, and then through an activated carbon absorber and an anion exchanger to remove albumin-bound toxins such as bile acids, bilirubin and fatty acids. The cleansed blood that passes via the MARS FLUX dialyzer is returned to the patient’s circulatory system to attract more toxins.

In addition to removing both albumin-bound and water-soluble toxins from the blood, MARS helps manage fluids, electrolytes and pH balance, affords a safety barrier between blood and absorber columns, helps control glucose and lactate levels, and provides an immediate means of regenerating albumin.

 

Researching MARS

Multiple small, uncontrolled trials have demonstrated the efficacy of MARS treatment for a number of specific indications, including hepatic encephalopathy, pruritus induced by severe cholestasis or jaundice, and Hepatorenal syndrome. The MARS system may also be effective for patients with acute exacerbation of chronic liver failure. Larger randomized and controlled studies are required to directly assess the efficacy of MARS compared to conventional treatment.

The utilization of MARS therapy highlights Emory’s institutional commitment and expertise to providing comprehensive, leading edge liver critical care services related to liver disease and hepatic failure.

As a matter of fact, Emory’s Liver Transplant Program currently ranks #1 in Georgia and #2 in the nation for patient survival paired with transplant volume. Our program is at the forefront of clinical excellence and technology related to the management of liver failure and liver transplantation. That is the Emory difference.

 

To learn more about the MARS system or to refer a patient:

1-855-EMORYTX (366-7989)

emoryhealthcare.org/txrefer

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